关键词:

经括约肌肛瘘, 改良括约肌间瘘管结扎术, 疗效, 并发症, 复发率

Abstract:

Objective　To explore the clinical efficacy and application value of modified ligation of intersphincteric fistula tract (LIFT) in the treatment of transsphincteric anal fistula. Methods　A retrospective controlled study was conducted. A total of 121 patients with transsphincteric anal fistula who underwent surgical treatment in the Department of Anorectal Surgery at Shangluo Traditional Chinese Medicine Hospital from January 2020 to December 2022 were selected as the study subjects. According to different surgical methods, patients were divided into an observation group (61 cases, receiving modified LIFT) and a control group (60 cases, receiving traditional LIFT). The observation group included 39 males and 22 females, with an average age of (42.65±8.27) years; the control group included 40 males and 20 females, with an average age of (43.12±7.96) years. Surgical-related indicators (operation time, intraoperative blood loss, length of hospital stay, wound healing time), postoperative pain scores [Visual Analog Scale (VAS)], postoperative complications, anal function assessment, and recurrence rates were compared between the two groups. Statistical analysis was conducted using χ² ,t and F tests and Fisher exact probability method. Results　The observation group had an operation time, intraoperative blood loss, length of hospital stay, and wound healing time of (45.37±8.62) minutes, (16.24±3.58) ml, (5.12±1.03) days, and (16.43±3.25) days, respectively, while the control group had (58.64±10.15) minutes, (25.37±4.76) ml, (7.38±1.42) days, and (21.87±4.19) days. All differences were statistically significant (t=7.84, 12.45, 10.23, 8.33, all P<0.001). Postoperative VAS scores at 24, 48, and 72 hours for the observation group were (4.25±0.83, 3.18±0.67, 2.04±0.52) points, which were all lower than those of the control group [(5.67±1.04, 4.52±0.89, 3.26±0.75) points], with all differences being statistically significant (all P<0.001). The total incidence of postoperative complications in the observation group was lower than that in the control group [6.56% (4/61) vs. 18.33% (11/60)] (χ²=4.13, P=0.042). At 3 months postoperatively, the Wexner anal function score in the observation group was (1.24±0.58) points, compared to (1.38±0.67) points in the control group, with no statistically significant difference (t=1.24, P=0.216). After 12 months of follow-up, there was no significant difference in the recurrence rate between the two groups(P>0.05). Conclusions　Modified LIFT in the treatment of transsphincteric anal fistula has the advantages of less surgical trauma, faster postoperative recovery, less pain and fewer complications. The recurrence rate has a decreasing trend, which can protect the function of anal sphincter and has high clinical application value.

Key words:

Transsphincteric anal fistula, Improved ligation of intersphincteric fistula tract, Curative effect, Complications, Recurrence rate